Bone stabilization systems

ABSTRACT

An aiming guide system configured for connection to a bone plate including an aiming arm and a connection assembly. The aiming arm has a rigid body extending from a proximal end to a distal end with a plurality of aiming holes defined through the rigid body between the proximal end and the distal end thereof. The distal end defines an attachment slot through the body. The connection assembly is configured to engage an attachment screw hole of the bone plate and the attachment slot such that the aiming arm is fixed in position relative to the bone plate with each of the aiming holes aligned with a respective hole along the bone plate.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent Ser. No.16/031,066 filed on Jul. 10, 2018, which is a continuation-in-part ofU.S. patent application Ser. No. 15/925,846, filed Mar. 20, 2018, whichis a continuation-in-part of U.S. patent application Ser. No. 15/703,345filed Sep. 13, 2017, which are incorporated by reference herein in theirentireties for all purposes.

FIELD OF THE INVENTION

The present disclosure relates to surgical devices, and moreparticularly, stabilization systems including plates, for example, fortrauma applications.

BACKGROUND OF THE INVENTION

Bone fractures can be healed using plating systems. During treatment,one or more screws are placed on either side of a fracture, therebycausing compression and healing of the fracture. There is a need forimproved plating systems as well as mechanisms for accurate use of theplating systems.

Full open reduction and internal fixation (ORIF) of distal femur platesoften requires an incision that would span much of the length of thefemur, increasing the potential for excessive stripping of the softtissue and/or periosteum and a higher chance of wound complications.Lateral distal femur plates are often inserted with an aiming guideassembly to assist in performing a minimally invasive (MIS) surgicalapproach. With an aiming guide, a surgeon can place and direct a platethrough one small incision at the knee as well as target the location ofshaft holes with small incisions up the femur. However, there is a needfor a guide system that provides an easy to use, distal connection withthe plate.

SUMMARY OF THE INVENTION

In accordance with the application, in some embodiments, a system isprovided for treating a fracture in a bone. The system comprises a boneplate configured to engage the bone, the bone plate comprising aproximal portion, a shaft and a distal portion, wherein the proximalportion comprises a tapered tip, wherein the shaft comprises one or moreholes, and wherein the distal portion comprises one or more distal holesand a posterior side and an anterior side, wherein the posterior side ofthe distal portion is raised relative to the anterior side of the distalportion. The system further comprises at least one fastener receivedthrough the one or more holes of the shaft and at least one fastenerreceived through the one or more distal holes of the distal portion.

In other embodiments, a system is provided for treating a fracture in abone. The system comprises a bone plate configured to engage the bone,the bone plate comprising a proximal portion, a shaft and a distalportion, wherein the proximal portion comprises a tapered tip, whereinthe shaft comprises one or more holes, and wherein the distal portioncomprises one or more distal holes and a posterior side and an anteriorside, wherein the one or more holes in the shaft are fixed holes whilethe one or more distal holes in the distal shaft are polyaxial lockingholes. The system further includes at least one fastener receivedthrough the one or more holes of the shaft and at least one fastenerreceived through the one or more distal holes of the distal portion.

In yet another embodiment, a system for treating a fracture in a boneincludes a bone plate configured to engage the bone, the bone plateextending along a longitudinal axis and comprising a proximal portion, ashaft, and a distal portion, the shaft comprises a plurality of holes(e.g., polyaxial holes), the plurality of holes include a firstrepeating pattern of holes and a second repeating pattern of holes, thefirst repeating pattern of holes having a first virtual line segmentconnecting center points of all of the first repeating pattern of holes,the second repeating pattern of holes having a second virtual linesegment connecting center points of all of the second repeating patternof holes, wherein the first virtual line segment and the second virtualline segment are parallel, and the first virtual line segment and thesecond virtual line segment are angled relative to the longitudinalaxis, and the distal portion comprises a plurality of distal holes and aposterior side and an anterior side, wherein the posterior side of thedistal portion is raised relative to the anterior side of the distalportion.

According to yet another embodiment, a system for treating a fracture ina bone includes a bone plate configured to engage the bone, the boneplate extending along a longitudinal axis and comprising a proximalportion, a shaft, and a distal portion, the shaft comprises a pluralityof holes (e.g., polyaxial holes), the plurality of holes include a firstrepeating pattern of holes and a second repeating pattern of holes, thefirst repeating pattern of holes having a first virtual line segmentconnecting center points of all of the first repeating pattern of holes,the second repeating pattern of holes having a second virtual linesegment connecting center points of all of the second repeating patternof holes, wherein the first virtual line segment and the second virtualline segment are parallel, and the first virtual line segment and thesecond virtual line segment are angled relative to the longitudinalaxis, and wherein the first repeating pattern includes a first centerhole and the second repeating pattern includes a second center hole, andthe center point of the first and second center holes are alignedgenerally along the longitudinal axis of the plate.

Also provided are kits including plates of varying shapes and sizes,bone anchors, fasteners, insertion tools, and components for installingthe same.

Also provided are aiming guide systems configured for connection to abone plate. In at least one embodiment, the aiming guide system includesan aiming arm and a connection assembly. The aiming arm has a rigid bodyextending from a proximal end to a distal end with a plurality of aimingholes defined through the rigid body between the proximal end and thedistal end thereof. The distal end defines an attachment slot throughthe body. The connection assembly is configured to engage an attachmentscrew hole of the bone plate and the attachment slot such that theaiming arm is fixed in position relative to the bone plate with each ofthe aiming holes aligned with a respective hole along the bone plate.

In at least one embodiment, the aiming guide system includes an aimingarm and a connection assembly. The aiming arm has a rigid body extendingfrom a proximal end to a distal end with a plurality of aiming holesdefined through the rigid body between the proximal end and the distalend thereof. The distal end defines an attachment slot through the body.The connection assembly is configured to engage an attachment screw holeof the bone plate and the attachment slot such that the aiming arm isfixed in position relative to the bone plate with each of the aimingholes aligned with a respective hole along the bone plate. Theconnection assembly includes an attachment post having a first end withan orienting boss extending from a mating surface. The orienting boss isconfigured to be received in the attachment slot such that the aimingarm rests on the mating surface and is maintained in a properorientation. A second end of the attachment post has an attachment blockhaving a distal surface which defines a plurality of ball end pins. Eachball end pin is configured to be received in a respective indentation onthe plate surface about the attachment screw hole. A threaded shaftextends through a through bore of the attachment post with threads of atleast one end of the shaft body configured to threadably engage theattachment screw hole. A fastener is configured to threadably engagethreads on an opposite end of the threaded shaft to secure theattachment post between the aiming arm and bone plate.

Also provided is a method of connecting an aiming guide arm to a boneplate wherein the aiming guide arm has a rigid body extending from aproximal end to a distal end with a plurality of aiming holes definedthrough the rigid body between the proximal end and the distal endthereof and the distal end defining an attachment slot through the body.The bone plate extends along a longitudinal axis and includes a proximalportion, a shaft, and a distal portion, the bone plate defining aplurality of first screw holes along shaft, a plurality of second screwholes at the distal portion, an attachment screw hole proximate thedistal portion and a plurality of indentations about the attachmentscrew hole. The method includes threadably engaging a first end of athreaded shaft in the attachment screw hole such that the threaded shaftextends from the bone plate at an oblique angle; sliding an attachmentpost over the threaded shaft such that ball end pins extending from anattachment block on one end of the attachment post seat within theindentations on the bone plate, the opposite end of the attachment posthaving an orienting boss extending from a mating surface; positioningthe aiming guide arm with the orienting boss extending through theattachment slot with a first surface of the aiming guide arm seated onthe mating surface; and securing a fastener to the second end of thethreaded shaft, the fastener engaging a second surface of the aimingguide body opposite the first surface to secure the aiming guide bodyrelative to the bone plate in a fixed orientation.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings, wherein:

FIG. 1 is a view of a bone plate on bone in accordance with someembodiments of the present application.

FIG. 2 is an alternate view of the bone plate on bone in FIG. 1.

FIG. 3 is a top perspective view of a narrow bone plate in accordancewith some embodiments of the present application.

FIG. 4 is a top perspective view of a broad bone plate in accordancewith some embodiments of the present application.

FIG. 5 is a view of an alternative bone plate on bone in accordance withsome embodiments of the present application.

FIG. 6 is a top view of a lengthened, narrow bone plate in accordancewith some embodiments of the present application.

FIG. 7 is a top view of a lengthened, broad bone plate in accordancewith some embodiments of the present application.

FIG. 8 is a top view of a medial plate in accordance with someembodiments of the present application.

FIG. 9 is a top perspective view of a representative plate including atwist up its shaft.

FIG. 10 is a cross-sectional view of a section of a representative plateshowing an arced contour of an underside.

FIG. 11 is a cross-sectional view of a different section of arepresentative plate showing an arced contour of an underside.

FIG. 12 is a top perspective view of another embodiment of a narrow boneplate.

FIG. 13 is a top perspective view of another embodiment of a broad boneplate.

FIG. 14 is a close-up view of the geometry of the broad bone plate ofFIG. 13.

FIG. 15 is a top view of another embodiment of a narrow bone plate.

FIG. 16 is a top view of another embodiment of a broad bone plate.

FIG. 17 is a perspective view of another embodiment of a medial lockingplate.

FIG. 18 is a perspective view of the epicondylar ridge on the end of afemur.

FIG. 19 illustrates the distal portion of the medial plate shown in FIG.17.

FIG. 20 is a side view of a portion of the medial plate shown in FIG.17.

FIG. 21 is a perspective view of an aiming guide system in accordancewith an embodiment of the disclosure shown attached to an illustrativebone plate.

FIG. 22 is a perspective view of the aiming arm of the aiming guidesystem of FIG. 21.

FIGS. 23 and 24 are cross-sectional views of aiming holes of narrow andbroad aiming arms, respectively.

FIG. 25 is a perspective view of an illustrative threaded shaft of theconnecting assembly of the aiming guide system of FIG. 21.

FIG. 26 is a perspective view of an illustrative attachment post of theconnecting assembly of the aiming guide system of FIG. 21.

FIG. 27 is a top plan view illustrating an alternative embodiment of theattachment slot and orienting boss.

FIG. 28 is a perspective view of the distal attachment block of theattachment post of FIG. 26.

FIG. 29 is a side elevation view illustrating connection of theconnecting assembly with the aiming arm.

FIG. 30 is a cross-sectional view illustrating the connecting assemblyfully assembled between the aiming arm and the bone plate.

FIG. 31 is a perspective view of an aiming guide system in accordancewith another embodiment of the disclosure shown attached to anillustrative bone plate.

FIG. 32 is a perspective view of the fixed axis fastener of the aimingguide system of FIG. 31.

FIG. 33 is a perspective view of an illustrative tissue protectionsleeve according to an embodiment of the disclosure.

FIG. 34 is an expanded elevation view of the proximal portion of thetissue protection sleeve of FIG. 33 engaged within an aiming hole of theaiming arm.

FIG. 35 is a perspective view of an illustrative drill sleeve accordingto an embodiment of the disclosure.

FIG. 36 is a cross-sectional view of the distal portion of the drillsleeve of FIG. 35 extending into a bone plate hole.

FIG. 37 is a cross-sectional view of an illustrative hole marker engagedwithin an aiming hole of the aiming arm.

DETAILED DESCRIPTION OF THE INVENTION

Embodiments of the present application are generally directed todevices, systems and methods for bone stabilization. In particular,embodiments are directed to bone plates that extend across bone membersto treat one or more fractures.

The plates described herein may be adapted to contact one or more of afemur, a distal tibia, a proximal tibia, a proximal humerus, a distalhumerus, a clavicle, a fibula, an ulna, a radius, bones of the foot,bones of the hand, or other suitable bone or bones. The bone plates maybe curved, contoured, straight, or flat. The plates may have a headportion that is contoured to match a particular bone surface, such as acondylar region, metaphysis or diaphysis. In addition, the plates mayhave a shaft portion that is contoured to match a particular surfacethat flares out in the form of an L-shape, T-shape, Y-shape. The platesmay be adapted to secure small or large bone fragments, single ormultiple bone fragments, or otherwise secure one or more fractures. Inparticular, the systems may include a series of trauma plates and screwsdesigned for the fixation of fractures and fragments in diaphyseal andmetaphyseal bone. Different bone plates may be used to treat varioustypes and locations of fractures.

The bone plates may be comprised of titanium, stainless steel, cobaltchrome, carbon composite, plastic or polymer—such aspolyetheretherketone (PEEK), polyethylene, ultra-high molecular weightpolyethylene (UHMWPE), resorbable polylactic acid (PLA), polyglycolicacid (PGA), combinations or alloys of such materials or any otherappropriate material that has sufficient strength to be secured to andhold bone, while also having sufficient biocompatibility to be implantedinto a body. Similarly, the bone plates may receive one or more screwsor fasteners may be comprised of titanium, cobalt chrome,cobalt-chrome-molybdenum, stainless steel, tungsten carbide,combinations or alloys of such materials or other appropriatebiocompatible materials. Although the above list of materials includesmany typical materials out of which bone plates and fasteners are made,it should be understood that bone plates and fasteners comprised of anyappropriate material are contemplated.

The bone plates described herein can include a combination of lockingholes and non-locking holes, only locking holes, or only non-lockingholes. Locking holes comprise one or more openings that accept one ormore locking fasteners. The one or more openings can be partially orfully threaded, thread-forming, or otherwise configured to allow lockingattachment of the fastener to the hole. In some embodiments, the holescomprise stacked or polyaxial locking holes, which can accept bothlocking and non-locking fasteners. In some embodiments, the lockingfasteners include heads that are at least partially threaded. Thelocking fasteners can be monoaxial or polyaxial. One non-limitingexample of a locking fastener (among others) is shown in FIG. 6 of U.S.Ser. No. 15/405,368, filed Jan. 13, 2017, which is (along with anysubsequent publication of the same application) hereby incorporated byreference in its entirety.

Non-locking holes comprise one or more openings for accepting one ormore non-locking fasteners. The one or more openings are at least inpart non-threaded. In some embodiments, these openings includenon-threaded or stacked openings, which can accept both locking andnon-locking fasteners. In some embodiments, the holes comprise stackedor polyaxial locking holes, which can accept both locking andnon-locking fasteners. The non-locking fasteners can be monoaxial orpolyaxial. One non-limiting example of a non-locking fastener (amongothers) is shown in FIG. 4 of U.S. Ser. No. 15/405,368, filed Jan. 13,2017, which is (along with any subsequent publication of the sameapplication) hereby incorporated by reference in its entirety. In someembodiments, the non-locking fasteners can include dynamic compressionscrews, which enable dynamic compression of an underlying bone.

In some embodiments, one or more of the plates described below includeboth locking and non-locking holes. Locking holes and locking fastenersmay be useful for patients that have weaker bone. In addition, these maybe helpful to prevent screw backout. Non-locking plates may be usefulfor patients that have strong bone.

In some embodiments, one or more of the plates described below cancomprise improved distal femoral plates. These plates can be used by asurgeon as an internal fixation device for a variety of fracturepatterns in the condylar region of the distal femur. Typical indicationscan include buttressing of comminuted/multi-fragmentary fractures,metaphyseal and supracondylar fractures, intra-articular andextra-articular femur fractures, periprosthetic fractures, fractures inosteopenic bone, osteotomies of the femur, and nonunions and malunions.

The one or more plates can provide a number of advantages, as will bediscussed further below. In particular, the plates are designed tobetter accommodate anatomical features. For example, one or more platescan include a raised posterior sideline that accommodates an epicondylarprotuberance. In addition, the plates have various holes or openings forreceiving various types of screws or fasteners, such as one or morekickstand screws, fixed screws, and/or polyaxial screws, that provideexcellent fixation while minimizing the risk of various deformities.

FIG. 1 is a view of a bone plate on bone in accordance with someembodiments of the present application. The bone plate 100 comprises adistal femur plate that is attached to a femur bone 5. The femur bone 5comprises a distal condylar region 7 and a shaft 17 having a lateralside 11 and a medial side 13. The condylar region 7 includes a pair ofmedial and lateral condyles and a pair of medial and lateral epicondyles9 positioned near the posterior edge of the condyles.

The bone plate 100 comprises a distal femur plate that comprises aproximal portion 102 and a distal portion 104. The proximal portion 102comprises a tapered insertion end that transitions into a shaft 110. Thedistal end of the shaft 110 flares out into a wider portion that formsthe head or distal portion 104 of the bone plate 100. While the proximalportion 102 and shaft 110 of the bone plate 100 reside along the shaft17 of the femur, the head or distal portion 104 of the bone plate 100resides along the condylar region 7 of the femur.

The proximal portion 102 and shaft 110 of the bone plate 100 areconfigured to receive one or more screws or fasteners 50. Likewise, thedistal portion 104 of the bone plate 100 is configured to receive one ormore screws or fasteners 52. In some embodiments, the fasteners 50 onthe proximal portion 102 and shaft 110 of the bone plate 100 comprisefixed angle fasteners, while the fasteners 52 on the distal portion 104of the bone plate 100 comprise polyaxial fasteners. It has been foundthat while fixed angle fasteners are often stronger than polyaxialfasteners and provide greater stiffness to a bone plate attached tobone, at times, bone plate stiffness can be too great, thereby impedingproper bone healing. Accordingly, the present application provides anovel bone plate 100 that can accommodate both fixed angle fasteners 50and polyaxial fasteners 52, thereby providing a balance between adequatestiffness and proper healing. In other embodiments, the bone plate 100can receive only fixed angle fasteners, thereby providing a bone plateof increased stiffness. In other embodiments, the bone plate 100 canreceive only variable angle fasteners, thereby providing a bone plate ofless stiffness. Moreover, polyaxial locking holes provide an opportunityto place a fastener at a variety of different angles relative to thebone plate, permitting the avoidance of other fasteners and/or implantsthat may already be in the bone. Therefore, the polyaxial locking holesprovide more options for a surgical user. FIG. 2 is an alternate view ofthe bone plate on bone in FIG. 1. From this view, one can see the boneplate 100 and its fasteners 50, 52 through the femur 5. As noted above,in some embodiments, fasteners 50 comprise fixed fasteners that enterthrough the shaft 17 of the femur 5. These fasteners 50 are shorterrelative to fasteners 52 and provide increased stiffness. In someembodiments, fasteners 52 comprise variable angle fasteners that enterthrough the condylar region 7 of the femur 5. These fasteners 52 arelonger relative to fasteners 50. While these fasteners 52 can providedecreased stiffness relative to the other fasteners 50, they also havemore variability in their angle of placement relative to one another andthe bone plate to provide more options for a surgical user.

FIG. 3 is a top perspective view of the narrow bone plate in accordancewith some embodiments of the present application. The bone plate 100comprises a proximal portion 102 and a distal portion 104. In betweenthe proximal portion 102 and distal portion 104 is a shaft 110 having ananterior sidewall 106 and a posterior sidewall 108. Along the length ofthe bone plate 100 are a series of holes or openings for receivingscrews or fasteners therein.

The proximal portion 102 of the bone plate 100 comprises a tapered tip120. In some embodiments, the tapered tip 120 serves as the lead portionof the bone plate 100 to enter into an incision. In some embodiments,the tapered tip 120 allows for simplified submuscular plate insertion tominimize incision length. The proximal portion 102 further comprises ak-wire hole 122 for receiving a k-wire therein to guide bone plate 100to a desired surgical site. The k-wire hole 122 allows for temporaryfixation of the bone plate 100 to bone via a k-wire. In someembodiments, the k-wire hole 122 is unthreaded. In addition, theproximal portion 102 further comprises an articulated tensioning device(ATD) slot 124. The ATD slot 124 is configured to receive a portion of atension or compression device (not shown) that can help to bring bonefragments together for healing. In some embodiments, the ATD slot 124 iscomposed of a through hole and a cylindrical shaped undercut on thebottom of the plate 100.

The proximal portion 102 transitions into the shaft portion 110. Theshaft portion 110 comprises multiple holes or openings 130 a, 130 b, 130c, 130 d, 130 e, 130 f that are configured to receive fasteners therein.In some embodiments, holes 130 a-130 f are configured to be fixed angle,stacked locking holes that can accommodate screws (e.g., between 3.5-7.5mm screws, such as 4.5 mm screws). The fixed angle, stacked lockingholes advantageously allow for mono-axial insertion of fasteners thatlock to the bone plate 100. In some embodiments, these holes can alsoaccommodate non-locking fasteners. In some embodiments, the holes 130a-130 f are arranged in series such that no two holes 130 a-130 foverlap along a width of the shaft portion 110.

In addition, the shaft portion 110 comprises one or more bi-directionaldynamic compression slots 132 a, 132 b interspersed between the holes130 a-130 f The slots 132 a, 132 b are elongated in length relative tothe holes 130 a-130 f, and are configured to receive one or morenon-locking fasteners therein. While the present embodiment illustratestwo dynamic compression slots 132 a, 132 b, in some embodiments, therecan be three or more compression slots. In some embodiments, the dynamiccompression slots 132 a, 132 b allow for static insertion of non-lockingscrews into the shaft portion 110 of the bone. In some embodiments, theyalso allow for compression (e.g., between 0.5-2 mm, such as 1 mm, ofcompression) along the shaft portion 110 of the bone through eccentricinsertion of a non-locking screw. In some embodiments, the locations ofthe dynamic compression slots 132 a, 132 b are optimized for typicalintercondylar splits and osteotomies.

In addition to the holes 130 a-130 f and the compression slots 132 a,132 b, the shaft 110 further comprises a kickstand hole 135. In someembodiments, the kickstand hole 135 comprises a polyaxial locking holefor receiving a locking fastener therein. The kickstand hole 135 isadvantageously designed to receive a fastener that targets the strongcortical bone in the posteromedial cortex of the condylar region,thereby promoting angular stability. Additionally, the kickstand hole isuseful for providing enhanced fixation for comminuted fractures in themetaphyseal region of the bone, due to its oblique angle relative to theupper surface of the plate. In some embodiments, the kickstand hole 135is angled between 23-33 degrees, or in some embodiments between 27-29degrees, upwards from a normal plane of the upper surface of the plate.

The shaft portion 110 comprises an anterior side 106 and a posteriorside 108 that form the edges of the shaft portion 110. The anterior side106 and posterior side 108 can include one or more waisted edge scallops136. Advantageously, the one or more waisted edge scallops 136 permitsome bending of the shaft portion 110 without deforming the holes,thereby promoting uniform load transfer. In some embodiments, the shaftportion 110 can have a pre-contoured geometry. Advantageously, thepre-contoured geometry can allow an optimal fit along an entire lateralaspect of a femur. In lengthier versions of the plate 100, there can bean anterior bow and slight shaft twist to mate with proximal femoralanatomy. In addition, in some embodiments, the underside of the boneplate 100 can be arced to mate with the cylindrical nature of thefemoral shaft.

The distal end of the shaft portion 110 transitions into the wider,distal portion 104 of the bone plate 100. The distal portion 104 of thebone plate 100 is configured to reside at or near the condylar region ofthe femur 5. The distal portion 104 comprises holes or openings 140 a,140 b, 140 c, 140 d, 140 e, 140 f, 140 g, 140 h that are configured toreceive one or more fasteners or screws therein. In some embodiments,the holes 140 a-140 h comprise polyaxial locking holes that canaccommodate screws (e.g., between 3.5-7.5 mm screws, such as 4.5 mmscrews). The locking holes may be thread-forming such that a thread isformed within the locking hole as the fastener is inserted therein. Insome embodiments, the polyaxial locking holes 140 a-140 h can have acone of angulation of up to between 30 to 50 degrees, and moreparticularly 40 degrees, according to some embodiments. The polyaxiallocking holes 140 a-140 h thus accommodate fasteners of differentangles. Advantageously, in some embodiments, the polyaxial locking holesare designed to accommodate multi-planar diverging trajectories to allowa surgeon to select optimal screw trajectories to avoid any existinghardware in the condylar region. In other words, fasteners inserted intothe condylar region will avoid other similarly inserted fasteners orother pre-existing hardware that may have been inserted previously inthe region. While the present embodiment includes eight polyaxial holes140 a-140 h, one skilled in the art will appreciate that the bone plate100 can include less than eight polyaxial holes or greater than eightpolyaxial holes. Furthermore, as the bone plate 100 can include bothfixed angle fasteners (e.g., in the shaft 110 of the bone plate 100) andpolyaxial fasteners (e.g., in the distal portion 104 of the bone plate100), the bone plate 100 can be provided relative to an underlying withjust enough stiffness to accommodate adequate healing.

In some embodiments, the holes 140 a-140 h can include one or more holesthat are nominally angled so that they are parallel to a knee joint.These holes can receive one or more fasteners or screws that areparallel to the knee joint, thereby helping in proper alignment of thebone plate 100 relative to bone. In the present embodiment, holes 140 b,140 d, 140 e can be parallel to a knee joint and can be considered to becondylar realignment holes. Advantageously, these condylar realignmentholes can help to restore the anatomic alignment of the articular blockto prevent varus/valgus deformities and post-traumatic arthritis. Inother words, holes 140 b, 140 d, 140 e (which are a subset of thepolyaxial holes 140 a-140 h) can help guide one or more fastenerstherethrough that are parallel to the knee joint, thereby helping toensure proper alignment between the bone plate and underlying bone. Byproviding proper alignment, this advantageously helps to preventvarus/valgus deformities and post-traumatic arthritis. One skilled inthe art will appreciate that while holes 140 b, 140 d, 140 e can beformed as condylar realignment holes, other holes in the distal end canalso be used for similar purposes.

In addition to the holes 140 a-140 h, the distal portion 104 of theplate 100 further comprises a distal pair of k-wire holes 142. Like theproximal k-wire hole 122, the k-wire holes 142 allow temporary fixationof the bone plate 100 to bone with k-wires.

In addition to the holes 140 a-140 h and k-wire holes 142, the distalportion 104 of the plate 100 further comprises three indentations 144.In some embodiments, the indentations 144 are rounded or spherical. Thepurpose of the indentations 144 is to help accommodate a portion of aninstrument (e.g., an attachment post of an associated aiming instrument,for example, as described with reference to FIGS. 21-34). The instrumentcan be used to accurately guide fasteners or screws into respectiveholes in the bone plate 100. The instrument can rest against one or moreof the indentations 144, thereby ensuring proper alignment andorientation between the instrument and the plate 100. Unlike the holes140 a-140 h and k-wire holes 142, the indentions 144 do not extendthrough the upper surface to the lower surface of the bone plate 100.Rather, they are formed partially along the height of the bone plate100.

The distal portion 104 of the plate 100 can have a distinct contour. Inparticular, the distal portion 104 of the plate 100 can comprise aconcave cutout or lag screw groove 148. Screws or fasteners cansometimes be placed externally to the bone plate 100 to lag fragments ofthe articular block prior to plate placement. The lag screw groove 148advantageously accommodates and/or permits placement of these externallag/compression screws.

In some embodiments, the distal portion 104 of the plate 100 furthercomprises a variable chamfered surface 149. The variable chamferedsurface 149 advantageously has different amounts of material removedfrom a top surface of the bone plate 100 at the distal end, therebypermitting a thinner surface in an area where soft tissue cover isminimal. This desirably helps to prevent irritation around the kneeregion.

In some embodiments, the distal portion 104 of the bone plate 100further comprises an anterior side and a posterior side, wherein theposterior side has a raised contour relative to the anterior side in avertical direction along the height of the bone plate 100. As shown inFIG. 3, the bone plate 100 comprises a raised posterior side 146 thatcan be between 2-10 mm higher than an anterior side. In someembodiments, the raised posterior side 146 has an underside that isbetween 2-10 mm higher than an underside of an opposing anterior side ofthe bone plate 100. The purpose of the raised posterior side 146 is thatit advantageously accommodates an anatomical ridge on the posterior sideof the femoral condyle known as the epicondyle. The raised posteriorside 146 is advantageously designed to reside or sit on the epicondyle,thereby providing a mechanism by which a surgeon can key the bone plate100 into place on the condylar surface. Furthermore, the raisedposterior side 146 helps to stabilize the bone plate 100 over a bone,which would likely be unsteady without the raised feature. In additionto the raised contour, the bone plate 100 also includes condylarcontouring around its distal perimeter to mimic the metaphyseal andepiphyseal anatomy to guide plate placement.

In some embodiments, the overall height or thickness of the bone plate100 can be variable along its length. In some embodiments, the height orthickness of the bone plate 100 can be greater in the shaft 110 than inthe distal portion 104. In some embodiments, the thickness in the shaft110 can be between 3.0-6.0 mm, while the thickness in the distal portion104 can be between 1.5-4.5 mm. The variable thickness advantageouslyprovides ideal stiffness to the bone plate 100, while also balancing theneed to be careful around surrounding tissue around the bone plate. Forexample, a less thick distal portion 104 can help reduce unnecessarycontact with adjacent tissue, thereby reducing irritation around a kneeregion.

FIG. 4 is a top perspective view of a broad bone plate in accordancewith some embodiments of the present application. The broad bone plate200 includes many similar features as the narrower bone plate 100, butis wider than the narrower bone plate 100. In some embodiments, a distalportion 204 of the bone plate 200 can be between 7-11 mm, orapproximately 9 mm, wider than the narrower bone plate 100. Thisadditional width permits space for additional (e.g., two or more)polyaxial locking holes 240, as well as one or more k-wire holes 242. Insome embodiments, a shaft portion 210 of the bone plate 200 can bebetween 5.5-9.5 mm, or approximately 7.5 mm, wider than the narrowerbone plate 100. This additional width permits space for additional fixedangle, stacked locking holes 230. In some embodiments, the additionalwidth of the shaft 210 provides space for two, three or more lockingholes 230 along its width.

The bone plate 200 comprises a proximal portion 202 and a distal portion204. In between the proximal portion 202 and distal portion 204 is ashaft 210 having an anterior sidewall 206 and a posterior sidewall 208.Along the length of the bone plate 200 are a series of holes or openingsfor receiving screws or fasteners therein.

The proximal portion 202 of the bone plate 200 comprises a tapered tip220. In some embodiments, the tapered tip 220 serves as the lead portionof the bone plate 200 to enter into an incision. In some embodiments,the tapered tip 220 allows for simplified submuscular plate insertion tominimize incision length. The proximal portion 202 further comprises ak-wire hole 222 for receiving a k-wire therein to guide bone plate 200to a desired surgical site. The k-wire hole 222 allows for temporaryfixation of the bone plate 200 to bone via a k-wire. In someembodiments, the k-wire hole 222 is unthreaded. In addition, theproximal portion 202 further comprises an articulated tensioning device(ATD) slot 224. The ATD slot 224 is configured to receive a portion of atension or compression device (not shown) that can help to bring bonefragments together for healing. In some embodiments, the ATD slot 224 iscomposed of a through hole and a cylindrical shaped undercut on thebottom of the plate 200.

The proximal portion 202 transitions into the shaft portion 210. Theshaft portion 210 comprises multiple holes or openings 230 a, 230 b, 230c, 230 d, 230 e, 230 f, 230 g, 230 h, 230 i, 230 j that are configuredto receive fasteners therein. In some embodiments, holes 230 a-230 j areconfigured to be fixed angle, stacked locking holes that can accommodatescrews (e.g., between 3.5-7.5 mm screws, such as 4.5 mm screws). Thefixed angle, stacked locking holes advantageously allow for mono-axialinsertion of fasteners that lock to the bone plate 200. In someembodiments, these holes can also accommodate non-locking fasteners. Insome embodiments, the holes 230 a-230 j are distributed such that no twoholes 230 a-230 j overlap along a width of the shaft portion 110.However, one skilled in the art will appreciate that the shaft portion210 is wide enough to accommodate two or more holes 230 a-230 jside-by-side. In the present embodiment, the shaft includes distinctgroups of three holes 230 a-230 j side-by-side along the entire lengthof the plate.

In addition, the shaft portion 210 comprises one or more bi-directionaldynamic compression slots 232 a, 232 b interspersed between the holes230 a-230 j. The slots 232 a, 232 b are elongated in length relative tothe holes 230 a-230 j, and are configured to receive one or morenon-locking fasteners therein. While the present embodiment illustratestwo dynamic compression slots 232 a, 232 b, in some embodiments, therecan be three or more compression slots. In some embodiments, the dynamiccompression slots 232 a, 232 b allow for static insertion of non-lockingscrews into the shaft portion 210 of the bone. In some embodiments, theyalso allow for compression (e.g., between 0.5-2 mm, such as 1 mm, ofcompression) along the shaft portion 210 of the bone through eccentricinsertion of a non-locking screw. In some embodiments, the locations ofthe dynamic compression slots 232 a, 232 b are optimized for typicalintercondylar splits and osteotomies. In the present embodiments, eachof the dynamic compression slots 232 a, 232 b is positioned adjacent toa pair of locking holes 230.

In addition to the holes 230 a-230 f and the compression slots 232 a,232 b, the shaft 210 further comprises a kickstand hole 235. In someembodiments, the kickstand hole 235 comprises a polyaxial locking holefor receiving a locking fastener therein. The kickstand hole 235 isadvantageously designed to receive a fastener that targets the strongcortical bone in the posteromedial cortex of the condylar region,thereby promoting angular stability. Additionally, the kickstand hole isuseful for providing enhanced fixation for comminuted fractures in themetaphyseal region of the bone, due to its oblique angle relative to theupper surface of the plate.

The shaft portion 210 comprises an anterior side 206 and a posteriorside 208 that form the edges of the shaft portion 210. The anterior side206 and posterior side 208 can include one or more waisted edge scallops236. Advantageously, the one or more waisted edge scallops 236 permitsome bending of the shaft portion 210 without deforming the holes,thereby promoting uniform load transfer. The waisted edge scallops 236are slightly larger than the waisted edge scallops 136 to take intoaccount the wider shaft. In some embodiments, the shaft portion 210 canhave a pre-contoured geometry. Advantageously, the pre-contouredgeometry can allow an optimal fit along an entire lateral aspect of afemur. In lengthier versions of the plate 200, there can be an anteriorbow and slight shaft twist to mate with proximal femoral anatomy. Inaddition, in some embodiments, the underside of the bone plate 200 canbe arced to mate with the cylindrical nature of the femoral shaft.

The distal end of the shaft portion 210 transitions into the wider,distal portion 204 of the bone plate 200. The distal portion 204 of thebone plate 200 is configured to reside at or near the condylar region ofthe femur 5. The distal portion 204 comprises holes or openings 240 a,240 b, 240 c, 240 d, 240 e, 240 f, 240 g, 240 h, 240 i, 240 j that areconfigured to receive one or more fasteners or screws therein. In someembodiments, the holes 240 a-240 j comprise polyaxial locking holes thatcan accommodate screws (e.g., between 3.5-7.5 mm screws, such as 4.5 mmscrews). In some embodiments, the polyaxial locking holes 240 a-240 jcan have a cone of angulation of up to between 30 to 50 degrees, andmore particularly 40 degrees, according to some embodiments. Thepolyaxial locking holes 240 a-240 j thus accommodate fasteners ofdifferent angles. Advantageously, in some embodiments, the polyaxiallocking holes are designed to accommodate several multi-planar divergingtrajectories to allow a surgeon to select optimal screw trajectories toavoid any existing hardware in the condylar region. In other words,fasteners inserted into the condylar region will avoid other similarlyinserted fasteners or other pre-existing hardware that may have beeninserted previously in the region. While the present embodiment includesten polyaxial holes 240 a-240 j, one skilled in the art will appreciatethat the bone plate 200 can include less than ten polyaxial holes orgreater than ten polyaxial holes. Furthermore, as the bone plate 200 caninclude both fixed angle fasteners (e.g., in the shaft 210 of the boneplate 200) and polyaxial fasteners (e.g., in the distal portion 204 ofthe bone plate 200), the bone plate 200 can be provided relative to anunderlying with just enough stiffness to accommodate adequate healing.

In some embodiments, the holes 240 a-240 j can include one or more holesthat are nominally angled so that they are parallel to a knee joint.These holes can receive one or more fasteners or screws that areparallel to the knee joint, thereby helping in proper alignment of thebone plate 200 relative to bone. In the present embodiment, holes 240 b,240 e, 240 f can be parallel to a knee joint and can be considered to becondylar realignment holes. Advantageously, these condylar realignmentholes can help to restore the anatomic alignment of the articular blockto prevent varus/valgus deformities and post-traumatic arthritis. Inother words, holes 240 b, 240 e, 240 f (which are a subset of thepolyaxial holes 240 a-240 j) can help guide one or more fastenerstherethrough that are parallel to the knee joint, thereby helping toensure proper alignment between the bone plate and underlying bone. Byproviding proper alignment, this advantageously helps to preventvarus/valgus deformities and post-traumatic arthritis. One skilled inthe art will appreciate that while holes 240 b, 240 e, 240 f areconsidered condylar realignment holes, these are only representative,and other holes in the distal portion can also be considered condylarrealignment holes.

In addition to the holes 240 a-240 j, the distal portion 204 of theplate 200 further comprises a distal pair of k-wire holes 242. Like theproximal k-wire hole 222, the k-wire holes 242 allow temporary fixationof the bone plate 200 to bone with k-wires.

In addition to the holes 240 a-240 j and k-wire holes 242, the distalportion 204 of the plate 200 further comprises three indentations 244.In some embodiments, the indentations 244 are rounded or spherical. Thepurpose of the indentations 244 is to help accommodate a portion of aninstrument (e.g., an attachment post of an associated aiminginstrument). The instrument can be used to accurately guide fasteners orscrews into respective holes in the bone plate 200. The instrument canrest against one or more of the indentations 244, thereby ensuringproper alignment and orientation between the instrument and the plate200. Unlike the holes 240 a-240 j and k-wire holes 242, the indentions244 do not extend through the upper surface to the lower surface of thebone plate 200. Rather, they are formed partially along the height ofthe bone plate 200.

In some embodiments, the distal portion 204 of the plate 200 furthercomprises a variable chamfered surface 249. The variable chamferedsurface 249 advantageously has different amounts of material removedfrom a top surface of the bone plate 200 at the distal end, therebypermitting a thinner surface in an area where soft tissue cover isminimal. This desirably helps to prevent irritation around the kneeregion.

In some embodiments, the distal portion 204 of the bone plate 200further comprises an anterior side and a posterior side, wherein theposterior side has a raised contour relative to the anterior side. Asshown in FIG. 4, the bone plate 200 comprises a raised posterior side246 that can be between 2-10 mm higher than an anterior side. In someembodiments, the raised posterior side 246 has an underside that isbetween 2-10 mm higher than an underside of an opposing anterior side ofthe bone plate 200. The purpose of the raised posterior side 246 is thatit advantageously accommodates an anatomical ridge on the posterior sideof the femoral condyle known as the epicondyle. The raised posteriorside 246 is advantageously designed to reside or sit on the epicondyle,thereby providing a mechanism by which a surgeon can key the bone plate200 into place on the condylar surface. Furthermore, the raisedposterior side 246 helps to stabilize the bone plate 200 over a bone,which would likely be unsteady without the raised feature. In additionto the raised contour, the bone plate 200 also includes condylarcontouring around its distal perimeter to mimic the metaphyseal andepiphyseal anatomy to guide plate placement.

FIG. 5 is a view of an alternative bone plate on bone in accordance withsome embodiments of the present application. The bone plate 300comprises a plate that is lengthier than the bone plates 100, 200 inprior embodiments. The bone plate 300 is designed to extend along amajority of the length of a femur 5. In some embodiments, as shown inFIG. 5, the bone plate 300 extends from the distal condylar region 7close to the proximal region 15 of the bone plate 300. By spanning theextending length, the bone plate 300 may help heal and prevent fracturesthat are higher up the femur and near the proximal region 15.Additionally, a lengthier bone plate can assist in providing a longerworking length, which helps to modulate the stiffness of the plate andscrew construct to promote faster healing.

FIG. 6 is a top view of a lengthened, narrow bone plate in accordancewith some embodiments of the present application. While the bone plate300 has a number of similar features to bone plates 100, 200, the boneplate 300 is much longer. In some embodiments, the bone plate 300 has alength of between 400 and 500 mm, such as approximately 460 mm.

The bone plate 300 can include three distinct regions, identified by theperforated lines. These regions include a proximal region 302, a medialregion 306 and a distal region 304.

The proximal region 302 comprises a tapered distal end that includes atapered tip 320, k-wire hole 322 and ATD slot 324. In addition, theproximal region 302 comprises a series of proximal holes 328. In someembodiments, these proximal holes 328 are polyaxial and nominally angledtoward the outer edge of the bone plate 300 in order to assist indodging a hip stem in the proximal femur. While the present embodimentshows ten proximal holes 328, in other embodiments, the proximal region302 includes less than ten or greater than ten proximal holes 328. Inaddition, while the present embodiment shows ten proximal holes 328 thatare similar to one another (e.g., polyaxial), in some embodiments, theproximal holes 328 can be a combination of monoaxial and polyaxiallocking holes, or just monoaxial holes.

The medial region 306 comprises a shaft region having a series of holesor openings for receiving fasteners or screws therein. As shown in FIG.6, some of the holes can be stacked holes 330 that can accept locking ornon-locking screws, while some of the holes can be elongated dynamiccompression slots 332 that can accept non-locking screws. In the presentembodiments, the medial region 306 comprises twelve stacked holes 330and two dynamic compression slots 332. However, one skilled in the artwill appreciate that in some embodiments, the medial region 306 caninclude less than or greater than twelve stacked holes 330 and twodynamic compression slots 332.

The distal region 304 of the bone plate 300 comprises a flared out,wider region that resides on a condylar region of bone. In someembodiments, the distal region 304 includes a pair of distal k-wireholes 342 for receiving guiding k-wires therein. The distal region 304further includes three indentations 344 that are configured to engage aportion of an instrument (e.g., an alignment post of an aiming guide).The distal region 304 further includes a series of holes or openings forreceiving one or more fasteners or screws therein. These include onekickstand hole 335 and eight polyaxial locking holes 340, which areadvantageously designed such that fasteners that are insertedtherethrough do not interfere with one another. In addition to thesefeatures, the distal region 304 can further include a lag screw groove348 and a raised posterior side 346 that can accommodate an epicondylarflare.

As shown in FIG. 6, the bone plate 300 comprises different types ofholes in the three distinct regions—proximal region 302, medial region306 and distal region 304. In some embodiments, the distal region 304,which encompasses the condylar region, comprises polyaxial locking holes328. In the medial region 306, the polyaxial locking holes 328 cantransition into non-polyaxial or fixed holes 330. In some embodiments,the fixed holes 330 can be stacked holes. In the proximal region 302,the fixed holes 330 can transition into polyaxial locking holes 340.

FIG. 7 is a top view of a lengthened, broad bone plate in accordancewith some embodiments of the present application. Like the bone plate300, bone plate 400 has a number of similar features to bone plates 100,200, but is much longer. In some embodiments, the bone plate 400 has alength of between 400 and 500 mm, such as approximately 460 mm. The boneplate 400 is also wider than the bone plate 300, thereby accommodating anumber of distinct hole patterns along its length.

The bone plate 400 can include three distinct regions, identified by theperforated lines. These regions include a proximal region 402, a medialregion 406 and a distal region 404. All three regions (402, 404, and406) can contain groups of two or more holes side-by-side along thelength of the plate. In the present embodiments, the shaft includesdistinct groups of three holes side-by-side along the entire length ofthe plate.

The proximal region 402 comprises a tapered distal end that includes ak-wire hole 422 and ATD slot 424. In addition, the proximal region 402comprises a series of proximal holes. In some embodiments, theseproximal holes comprise polyaxial locking holes 428 that are nominallyangled toward the outer edge of the bone plate 400 in order to assist indodging a hip stem in the proximal femur. In between pairs of polyaxiallocking holes 428 are stacked holes 426. In some embodiments, both thepolyaxial locking holes 428 and stacked holes 426 can receive locking ornon-locking fasteners. In the present embodiment, the proximal region402 comprises five sets of holes, whereby each set comprises a pair ofpolyaxial locking holes 428 and a stacked hole 426.

The medial region 406 comprises a shaft region having a series of holesor openings for receiving fasteners or screws therein. As shown in FIG.7, some of the holes can be stacked holes 430 that can accept locking ornon-locking screws, while some of the holes can be elongated dynamiccompression slots 432 that can accept non-locking screws. In the presentembodiments, the medial region 406 comprises seven sets of holes,whereby each set comprises two or more stacked holes 430. In some of thesets, at least one dynamic compression slot 432 is provided between thetwo or more stacked holes.

The distal region 404 of the bone plate 400 comprises a flared out,wider region that resides on a condylar region of bone. In someembodiments, the distal region 404 includes a pair of distal k-wireholes 442 for receiving guiding k-wires therein. The distal region 404further includes three indentations 444 that are configured to engage aportion of an instrument (e.g., an alignment post of an aiming guide).The distal region 404 further includes a series of holes or openings forreceiving one or more fasteners or screws therein. These include onekickstand hole 435 and ten polyaxial locking holes 440, which areadvantageously designed such that fasteners that are insertedtherethrough do not interfere with one another. In addition to thesefeatures, the distal region 404 can further include a raised posteriorside 446 that can accommodate an epicondylar flare.

FIG. 8 is a top view of a medial plate in accordance with someembodiments of the present application. The medial plate 500 is insertedthrough an incision over the anteromedial of the distal femur or anS-shaped incision on the posterior side of the knee joint. The medialplate 500 includes similar features as the narrow and broad lockingplates 100, 200. In some embodiments, the longest length of the medialplate will sit no less than 8 cm below the lesser trochanter in order topreserve the vessels and nerve pathways on the medial side of the femur.In some embodiments, the thickness of the plate 500 varies along alength of the plate 500. For example, the plate 500 can be thicker in aproximal region (e.g., between 2.0-4.0 mm, such as approximately 3.0 mm)than in a distal region (e.g., between 1.5-3.0 mm, such as approximately2.25 mm).

The medial plate 500 comprises a proximal portion 502 and a distalportion 504 and a shaft 510 therebetween 510. The proximal portion 502comprises a tapered insertion tip 520. Along the proximal portion 502and shaft 510 are a series of holes 530 for receiving fasteners therein.In some embodiments, the holes 530 are polyaxial locking holes. In otherembodiments, the holes 530 are fixed angled stacked locking holes. Insome embodiments, the holes 530 are a combination of polyaxial lockingholes or fixed angle stacked locking holes. In some embodiments, theholes 530 accommodate screws of various sizes, such as between 3.5-7.5mm screws, such as approximately 4.5 mm. The shaft 510 further includeswaisted edge scallops 536.

The distal portion 504 of the medial plate 500 comprises similarfeatures as in prior embodiments, including a pair of distal k-wireholes 542 and six polyaxial locking holes 540. The polyaxial lockingholes 540 can accommodate fasteners or screws that are between 3.0 and6.0 mm, or approximately 4.5 mm. Furthermore, the distal portion 504comprises a raised posterior side 546 to accommodate an epicondylarflare, as well as condylar contouring 506 to accommodate distinctanatomy. In some embodiments, the distal portion 504 also comprises avariable chamfered surface 549.

FIG. 9 is a top perspective view of a representative plate including atwist up its shaft. From this view, one can see how the proximal portionof the representative shaft 300 can have an upward twist from a moremedial section of the plate. The advantage of the upward twist is thatthe plate is a better anatomical fit with bone.

FIG. 10 is a cross-sectional view of a section of a representative plateshowing an arced contour of an underside. FIG. 11 is a cross-sectionalview of a different section of a representative plate showing an arcedcontour of an underside. From these views, one can see how the arcedsurface varies in radius and centrality along the length of the plate.For example, the underside in FIG. 10 has a radius of R1, while theunderside in FIG. 11 has a radius of R2, wherein R1 is different fromR2. By having different arced contours along different sections of theplate, this also helps to give the plate a better anatomical fit tobone. In some embodiments, R1 and R2 can have a dimension between about25 mm to 250 mm, whereby R1 is different from R2.

Turning now to FIG. 12, a top perspective view of a narrow bone plate600 according to yet another embodiment is shown. The narrow bone plate600 is similar to narrow bone plate 100 shown in FIG. 3 and likeelements are labeled the same. Similar to plate 100, bone plate 600comprises proximal portion 102 and distal portion 104 with shaft 110extending therebetween having anterior sidewall 106 and posteriorsidewall 108.

Similar to holes or openings 130 a-130 f in plate 100, plate 600includes a plurality of holes or openings 130 a-130 g that areconfigured to receive fasteners therein. In some embodiments, holes 130a-130 g may be configured as locking holes, which may be able to acceptlocking or non-locking screws. The openings 130 a-130 g may be in theform of 4.5 mm polyaxial locking holes. The openings 130 a-130 g may bestaggered to prevent new linear fracture lines in the metaphyseal anddiaphyseal regions.

Similar to plate 100, the shaft portion 110 of plate 600 comprises oneor more bi-directional dynamic compression slots 132 a, 132 b. Theseslots 132 a, 132 b may be configured to receive one or more non-lockingfasteners therein and may allow for compression along the shaft portion110 of the bone. The bi-directional dynamic compression slots 132 a, 132b may allow for static insertion of non-locking screws into the shaft ofthe bone and/or may allow for 1 mm of compression along the shaft of thebone through eccentric insertion of a non-locking screw. The locationsof the dynamic compression slots 132 a, 132 b were optimized for typicalintercondylar splits and osteotomies.

The articulated tensioning device (ATD) hole 124 is composed of athrough hole in the tip of the plate 600 and a cylindrical shapedundercut on the bottom surface of the plate 600. The hole mates with anATD and allows for compression or tensioning of fracture fragments.

Plate 600 further includes a plurality of kickstand holes 135. Forexample, in this embodiment, the shaft portion 110 may include twokickstand holes 135 separated from one another and oriented in differentdirections. The kickstand holes 135 may each comprise a polyaxiallocking hole for receiving a locking fastener therein. In themetaphyseal region of the lateral plates, the two kickstand strut screwspermit fixation in the anteromedial and posteromedial cortices of themedial femoral condyle in the lateral plates. The screw targets thestrong cortical bone of the posteromedial cortex in order to enhancescrew fixation, prevent pull-out, and promote angular stability viatriangular fixation.

The anterior side 106 and posterior side 108 can include one or morewaisted edge scallops 136. Advantageously, the one or more waisted edgescallops 136 permit some bending of the shaft portion 110 withoutdeforming the holes, thereby promoting uniform load transfer.

The distal end of the shaft portion 110 transitions into the wider,distal portion 104 of the bone plate 600. Similar to plate 100, plate600 includes holes or openings 140 a-140 h that are configured toreceive one or more fasteners or screws therein, including locking ornon-locking screws. The holes 140 a-140 h may comprise polyaxial lockingholes, for example, with a cone of angulation. The cluster of holes 140a-140 h may be nominally targeted in several multi-planar divergingtrajectories to allow the surgeon to select optimal screw trajectoriesto avoid any existing hardware in the condyle.

The distal portion 104 of the plate 600 may further comprises a distalpair of k-wire holes 142. Like the proximal k-wire hole 122, the k-wireholes 142 allow temporary fixation of the bone plate 600 to bone withk-wires.

The distal portion 104 of the plate 600 may include three indentations144, for example, or blind openings being rounded or spherical, to helpaccommodate a portion of an instrument (e.g., an attachment post of anassociated aiming instrument).

In this embodiment, plate 600 further includes a dedicated aiming armattachment hole 602. The dedicated aiming arm attachment hole 602 may bea threaded hole, for example, for attaching the attachment post of anassociated aiming instrumentation for the system.

The thickness of the plate 600 may vary from about 4.5 mm proximally to3.6 mm distally, varying through the metaphyseal and epiphyseal regions.The transition in thickness may begin about 129 mm from the most distaledge of the plate 600. The width of the plate 600 may vary from about 33mm wide in the head of the plate 600 to about 17.5 mm wide in the shaftof the plate 600. The transition in width may also begin about 129 mmfrom the most distal edge of the plate 600.

Turning now to FIGS. 13 and 14, a broad lateral bone plate 700 accordingto yet another embodiment is shown. The broad lateral bone plate 700 issimilar to broad bone plate 200 shown in FIG. 4 and like elements arelabeled the same. Similar to plate 200, bone plate 700 comprisesproximal portion 202 and distal portion 204 with shaft 210 extendingtherebetween having anterior sidewall 206 and posterior sidewall 208.The broad lateral locking plate 700 may be inserted through an incisionover the lateral aspect of the distal femur and may provide some of thesame types of features as the narrow version 600.

The shaft portion 210 comprises a plurality of holes or openings 230 a,230 a 1, 230 b, 230 c, 230 d, 230 e, 230 f, 230 g, 230 h, 230 i, 230 i1, 230 j, 230 k, 2301 that are configured to receive fasteners therein.As compared to plate 200, plate 700 replaces dynamic compression slots232 a, 232 b with openings 230 a 1 and 230 i 1 and additional openings230K and 230 l are added. The plurality of openings 230 a-2301 may be4.5 mm polyaxial locking holes in the distal cluster that may benominally targeted in several multi-planar diverging trajectories toallow the surgeon to select optimal screw trajectories to avoid anyexisting hardware in the condyle. The plurality of openings 230 a-2301may accept locking or non-locking screws. The plurality of openings 230a-2301 in the shaft 210 of the plate 700 may be staggered to prevent newlinear fracture lines in the metaphyseal and diaphyseal regions. Inparticular, the plurality of openings 230 a-2301 may be a repeatingpattern of three holes (e.g., 230 a, 230 a 1, 230 b).

As best seen in FIG. 14, a first virtual line segment L1 connecting arepeating pattern of three holes (e.g., 230 c-230 e) through theirrespective center points may be angled relative to the longitudinal axisA of the plate 700. Similarly, a second virtual line segment L2connecting a repeating pattern of three holes (e.g., 230 f-230 h)through their respective center points may be angled relative to thelongitudinal axis A of the plate 700. Although two virtual line segmentsL1, L2 are shown it is evident that the same repeating pattern of threeholes repeats along the length of the plate 700. Each line segment L1,L2 connecting a repeating pattern of three holes through theirrespective center points may be generally aligned substantially parallelto one another.

The center point of the center hole 230 d, 230 g of each repeatingpattern may be aligned generally along the longitudinal axis A of theplate 700. In addition, indentations 238 of the scallop 236 along theanterior and posterior sidewalls 206, 208 may be generally aligned withthe center hole 230 d, 230 g of each repeating pattern. As best seen inFIG. 14, the center of the scallops 236 on both of the side surfaces206, 208 are aligned with the center of the middle row of shaft holes.The indentations 238 of the scallop 236 along the side surfaces 206, 208lie on an axis which is perpendicular to the centered longitudinal axisA along the length of the shaft 210. In particular, a virtual linesegment L3 connecting a center point for the radius of a firstindentation 238 on anterior sidewall 206 to a center point for theradius of a second indentation 238 on the posterior sidewall 208 aregenerally aligned with the center of the center hole 230 d. Similarly, avirtual line segment L4 connecting a center point for the radius of athird indentation 238 on anterior sidewall 206 to a center point for theradius of a fourth indentation 238 on the posterior sidewall 208 aregenerally aligned with the center of the center hole 230 g. It willagain be appreciated that although two virtual line segments L3, L4 areshown it is evident that the same repeating pattern of three holesrepeats along the length of the plate 700. The undulating scallops 236result in a shaft profile which continually varies in overall width.

Plate 700 further includes a plurality of kickstand holes 235. Forexample, in this embodiment, the shaft portion 210 may include twokickstand holes 235 separated from one another and oriented in differentdirections. The kickstand holes 235 may each comprise a polyaxiallocking hole for receiving a locking fastener therein. The polyaxiallocking kickstand strut holes 235 are designed to target the strongcortical bone in the anteromedial and posteromedial cortices of themedial condyle and promote angular stability.

Similar to plate 600, plate 700 includes a dedicated aiming armattachment hole 702 and a plurality of indentations 244 surrounding theattachment hole 702. The dedicated aiming arm attachment hole 702 may bea threaded hole, for example, for attaching the attachment post of anassociated aiming instrumentation for the system. As shown, the threeindentations 244 or blind openings may be rounded or spherical, to helpaccommodate a portion of an instrument (e.g., an attachment post of anassociated aiming instrument).

The distal portion 204 of the bone plate 700, configured to reside at ornear the condylar region of the femur 5, may include a plurality ofholes or openings 240 a, 240 b, 240 c, 240 d, 240 e, 240 f, 240 g, 240h, 240 i, such as polyaxial locking holes, that are configured toreceive one or more fasteners or screws therein. This is substantiallysimilar to plate 200 except hole 240 j is omitted. One or more k-wireholes 242 may also be positioned in the distal portion 204 of the plate700.

The thickness of the plate 700 may vary from about 4.5 mm proximally toabout 3.6 mm distally varying through the metaphyseal and epiphysealregions. Like the narrow plate 600, the transition in thickness maybegin about 129 mm from the most distal edge of the plate. The width ofthe plate may vary from about 39 mm wide in the head of the plate 700 toabout 24 mm wide in the shaft 210 of the plate 700. The transition inwidth also begins about 129 mm from the most distal edge of the plate700.

The main differentiating qualities between the broad plate 700 and thenarrow plate 600 are the overall size of the plates and the total numberof each type of feature. The distal portion of the plate 700 is about 6mm wider than that of the narrow plate 600, thereby permitting space forone additional 4.5 mm polyaxial locking hole resulting in a total of 9polyaxial holes in the distal cluster. As this plate 700 is designed tofill the majority of the lateral femoral condyle and/or abut against thefemoral component of a total knee arthroplasty, the lag screw groove iseliminated in the broad plate 700.

The shaft 210 of the broad plate 700 is about 6.5 mm wider than that ofthe narrow plate 600. With more space, the alternating pattern ofpolyaxial locking holes in the shaft is increased from 2-wide to 3-wide.Additionally, the waisted edge scallops 236 are slightly larger to takeinto account the wider shaft 210.

FIGS. 15 and 16 show the longest lengths for each of the two lateralplates 800, 900. These plates 800, 900 are substantially the same asthose shown in FIGS. 6 and 7, respectively, and like elements arelabeled the same. In these embodiments, the plates 800, 900 furtherinclude an additional kickstand opening, 335, 435, respectively, and theassociated indentations or blind openings 144, 244, respectively, tohelp accommodate a portion of an instrument (e.g., an attachment post ofthe associated aiming instrument). The total length of these plates 800,900 is about 458 mm and the radius of curvature (i.e. anterior bow) isabout 1200 mm. Plate lengths decrease by approximately 31-33 mm,resulting in 11 lengths of each lateral plate and a shortest length ofabout 137 mm.

The pattern of staggered polyaxial holes 330, 430 occurs in the shaft ofboth lateral plates. The staggered hole pattern in the shaft providesincreased pull-out resistance and helps to prevent new linear fracturelines in the metaphyseal and diaphyseal regions. Two DCP slots 332 breakthe stacked hole pattern at the 1st and 6th holes in the narrow plate(FIG. 15), which may be useful in non-unions and osteotomies.

In the broad plate 900, the polyaxial holes 430 follow the three-holediagonal pattern, described with reference to FIG. 14, along the entirelength of the shaft, nominally angled parallel to the center row ofholes 430 but can be targeted inwards or outwards in order to dodgeother implants such as total hip or knee arthroplasties.

Turning now to FIG. 17, the medial locking plate 1000 is similar toplate 500 shown in FIG. 8 and like elements are numbered the same.Medial locking plate 1000 may be advantageous in that the bottom surface508 of the plate 1000 in contact with bone is anatomically contoured toabut the corresponding contours of the adjacent bone. For example, FIG.18 illustrates the epicondylar ridge 1002 of the medial condyle, whichis a bony protrusion located on the medial side of the femur's distalend. In order to accommodate the epicondylar ridge 1002, the plate 1000may include one or more of a raised posterior edge H1, an anteriorradius R3, and a raised height H2. As shown in FIG. 19, the posterioredge 546 may be raised relative to the anterior edge 548 to conform tothe average height of the epicondylar ridge 1002 of the medial condyle.For example, the posterior edge 546 may be higher than anterior edge 548by a height H1. Height H1 of the raised posterior edge 546 may be about10-14 mm, or about 12 mm, as compared to the anterior edge 548. Turningto FIG. 20, the bottom surface 508 of the plate 1000 may include ananterior radius R3. The anterior radius R3, for example, along theanterior edge 548, may be contoured to the distal end of the femur. Forexample, the radius R3 may range from about 28-32 mm, or about 30 mm. Inaddition, the height H2 of the distal portion 504 may be raised relativeto the shaft 510 of the plate 1000. For example, the height H2 may beabout 9-10 mm, or about 9.5 mm. The anterior radius R3 and raised heightH2 relative to the plate shaft 510 are designed to conform to theaverage size of the anteromedial third of the medial condyle. Theseunique anatomic features provide for a better fit to the bone and mayprovide better patient outcomes.

Plate 1000 may include holes 530, 540, kickstand holes 535, articulatedtensioning device (ATD) hole 524, and k-wire holes 522, 542 as alreadydescribed herein. The holes 530, 540 may be locking holes, such aspolyaxial locking holes. In particular, the locking holes may bethread-forming holes such that the fastener locks to the plate 1000 wheninserted therein. The locking holes 530, 540, for example, provided inall portions of the plate 1000, permit the creation of a fixed angleconstruct which helps to prevent both varus collapse and screw backout,even in cases of osteoporosis.

The medial locking plate 1000 may be inserted through an incision overthe anteromedial aspect of the distal femur or an S-shaped incision onthe posterior side of the knee joint. The plate 1000 is designed to siton the most anterior third of the medial condyle, directly on top of themedial epicondyle. Plate 1000 may provide the same types of features asthe narrow and broad lateral plates including all polyaxial lockingholes 540 in the distal cluster and polyaxial locking holes 530 alongthe shaft 510 and two polyaxial locking kickstand strut holes 535designed to target the strong cortical bone in the posterolateral cortexof the condyle and promote angular stability. The thickness of the plate1000 may vary from about 3.0 mm proximally to about 2.25 mm distallywith the transition occurring in the metaphyseal region of the plate1000.

Unlike other plates that may lead to misplacement or are improperlycontoured, the plates described in embodiments herein may have raisedcontours on their respective posterior sides to sit more flush on thecondylar anatomy and provide surgeons with a way to key in the plate inthe correct location. By having a large number of options for fixationalong the plates, helps in preventing varus collapse and loss offixation in poor bone quality. Many options for points of fixationbecome even more important in highly comminuted articular blocks or whenother existing implants may need to be avoided.

Referring to FIGS. 21-37, an aiming guide system 1100 in accordance withan embodiment of the disclosure will be described. Generally, the aimingguide system 1100 includes an aiming arm 1102 that attaches to the boneplate 300 via a connection assembly 1128 that includes a singleattachment post 1140 and threaded shaft 1130 engaged with the plate 300.While the aiming guide system 1100 is shown and described with respectto bone plate 300, it is understood that the system 1100 may be sizedand configured to be utilized with various bone plates including theother plates described herein. The angle of the attachment post 1140relative to the top surface of the plate 300 is designed such that thepost 1140 and subsequent assembly items do not block access to thedistal cluster of screw holes 340 in the plate. The aiming arm 1102 keysinto place on the attachment post 1140 and is oriented with the properside facing up (for a left femur procedure, the surface label “LEFT”should be facing up). A two-piece fastener completes the assembly of theaiming arm 1102 to the plate 300, including a washer 1160 which laysflush against the upper surface of the aiming arm 1102 and a sphericalnut 1170 that tightens onto the threaded shaft 1130.

Referring to FIG. 21, the aiming arm 1102 accepts tissue protectionsleeves 1180. The sleeves 1180 provide a portal into small incisionsthrough which trocars 1245, drill sleeves 1210, k-wire sleeves 1236,dynamic compression sleeves 1250, drills 1230, drivers, and screws maypass. The sleeves 1180 clip into place on either surface of the aimingarm 1102 (depending on whether the procedure is being performed on aright or left femur). The accurate and rigid interface of the sleeves1180 with the aiming arm 1102 functions to properly align the sleeves1180 to provide the nominal (0°) angle of the holes 328, 330, 332 in theshaft of the plate 300. The kickstand sleeve 1180′ is another type oftissue protection sleeve, providing a similar portal for trocars, drillsleeves, and the like, but is designed to align with the two oblique“kickstand” screw holes 335 in the plate 300.

Having generally described the aiming guide system 1100, illustrativecomponents, along with assembly and operation thereof, will bedescribed. Referring to FIG. 22, the aiming arm 1102 has a generallyrigid body 1104 extending from a proximal end 1103 to a distal end 1105.The arm body 104 has a length shorter than the plate 300 such that theproximal end 1103 thereof is slightly distal of the proximal end 302 ofthe plate 300 and the distal end 1105 is proximal of the distal end 304of the plate 300 such that the screw holes 340 remain unobstructed. Anattachment area 1106 extends from the distal end 1105 of the arm body1104 and defines an attachment slot 1108 extending through the arm body1104. The attachment slot 1108 is configured to receive the orientingboss 1146 on the attachment post 1140 as will be described in moredetail hereinafter. As illustrated in FIG. 21, upon connection of theaiming arm 1102 to the plate 300, the attachment area 1106 is offset tothe side of plate 300 and does not obstruct the plate 300.

The arm body 1104 may be manufactured from a radiolucent material toprevent obstructing lateral imaging during the procedure. The aiming arm1102 may be configured to be reversible, i.e. when one surface is facingupward, the arm 1102 is configured for a lefthanded plate and when theopposite surface is facing upward, the arm 1102 is configured for arighthanded plate. Additionally, the arm body 1104 may have differentconfigurations for narrow lateral plates versus broad lateral plates. Inat least one embodiment, there is one left-right reversible arm for thenarrow lateral plate and one left-right reversible arm for the broadlateral plate. A plate identifier 1107 may be printed on each surface toidentify to the user the arm configuration and orientation. Additionallyor alternatively, in at least one embodiment, the attachment location ofthe aiming arm 1102 to the attachment post 1140 may include a roundedgroove or slot to accept a ball-end pin or the like in the orientingboss 1146 of the attachment post 1140 only when the aiming arm 1102 isassembled in the correct orientation, as described hereinafter withrespect to FIG. 27.

Referring to FIGS. 22-24, a plurality of aiming holes 1110 are definedthrough the aiming arm 1102. Each aiming hole 1110 has a through bore1112 which extends through the arm body 1104 and aligns with arespective screw hole 328, 330, 332 of the plate 300 when the aiming arm1102 is attached relative to the plate 300. The aiming holes 1110 may benumbered with indicators 1118 on the side and/or each surface of the armbody 1104 to indicate the associated targeted hole 328, 330, 332 in theplate 300.

Each aiming hole 1110 includes, on each surface of the arm body 1104, arecess 1114 about the through bore 1112. The recesses 1114 areconfigured to receive a portion of the head member 1186 of a tissueprotection sleeve 1180. The recess 1114 preferably has a non-round shapewhich complements the shape of the head member 1186 such that the headmember 1186 is received and retained in a fixed position. An undercut1116 is defined within each recess 1114 to receive a locking tab 1196 onthe tissue protection sleeve 1180, as will be described in more detailhereinafter.

In both the narrow and broad aiming arms, the recess 1114 and undercut1116 features are mirrored about the mid-plane of the aiming arm 1102such that tissue protection sleeves 1180 can be inserted from eitherside of the reversable embodiment of the aiming arm 1102. The undercuts1116 meet at the mid-plane of each bore 1112, resulting in a continuousgroove in which the retention ledge 1198 of the locking tab 1196 willsit. In the narrow aiming arm as illustrated in FIG. 23, the undercut1116 is fully circumferential about the central axis of each bore 1112.In the broad aiming arm as illustrated in FIG. 24, the axis ofrevolution of the undercut 1116 is offset by 2 mm, resulting in anundercut which only consumes about 35% of the circumference of each bore1112.

Referring again to FIG. 22, a projection 1120 extends outwardly fromeach side of the arm body 1104. Each projection 1120 defines upper andlower sloped surfaces 1122. A kickstand targeting hole 1124 is througheach sloped surface 1122 and has an axis generally perpendicular to thesloped surface 1122. Each kickstand targeting hole 1124 exits theprojection on the opposite surface of the arm body 1104 at an exit hole1126. The kickstand targeting holes 1124 permit nominal targeting of thetwo oblique kickstand screw holes 335 in the distal cluster of the plate300. Each kickstand targeting hole 1124 may have a visual indicator 1118next to the hole. For example, the holes may be labeled A for anteriorand P for posterior.

A connection assembly 1128 in accordance with an embodiment of thedisclosure will be described with reference to FIGS. 25-30. Theconnection assembly 1128 a threaded shaft 1130, a single attachment post1140, and a two-piece fastener including a washer 1160 and a sphericalnut 1170. Referring to FIG. 25, the threaded shaft 1130 includes a shaftbody 1132 extending between ends 1131 and 1133. Each end 1131, 1133includes threads 1134, 1136, respectively, and a driver-receiving bore1135, for example, configured to receive a hexalobe screwdriver. Thethreaded shaft 1130 is preferably reversible, with identical threads1134, 1136 at each end. In at least one embodiment, the tips of thethreaded shaft contain a blunted first thread 1137 to promoteself-centering of the shaft 1130 and help prevent cross-threading in theplate 300. While not illustrated, it is recognized that the threadedshaft 1130 may be cannulated through its long central axis to permit theplacement of a k-wire through the attachment slot 1108 of the aiming arm1102 for preliminary fixation.

The attachment post 1140 includes a hollow tube 1142 extending from aproximal end 1141 to a distal end 1143. A radial mating surface 1148extends outwardly from the proximal end 1141 of the tube 1142 and theorienting boss 1146 extends upwardly from the mating surface 1148. Themating surface 1148 extends at an acute angle relative to the axis ofthe hollow tube 1142. The mating surface 1148 is oriented such that theaiming arm 1102 will lie flat on the mating surface 1148 when slid overthe orienting boss 1146. The orienting boss 1146 preferably has aconfiguration which dictates the orientation of the aiming arm 1102. Forexample, in the illustrated embodiment, the orienting boss 1146 has arectangular configuration such that when the orienting boss 1146 isengaged within the attachment slot 1108 of the aiming arm 1102, theaiming arm 1102 must be properly aligned with the bone plate 300. Theorienting boss 1146 is not limited to a rectangular configuration, butmay have other configurations, for example, oval shaped, trapezoidal,pentagonal.

Additionally, or alternatively, a keying feature may be provided betweenthe attachment slot and the orienting boss. In the embodimentillustrated in FIG. 27, one face of the orienting boss 1146′, forexample, the proximal side, includes a ball-end pin 1147 or other keyingmember extending therefrom. The ball-end pin 1147 is positioned somedistance away from the center plane of the boss 1146′. The attachmentarea 1106′ of the arm body 1104′ defines an attachment slot 1108′ with acorresponding groove 1109 positioned to receive the keying member 1147provided the aiming arm 1102 is in the proper orientation. Since thekeying member 1147 is off center, if the arm body 1104′ illustrated inFIG. 27 was flipped over, the groove 1109 would no longer align with thekeying member 1147 and the orienting boss 1146′ would not be receivablein the attachment slot 1108′.

An attachment block 1150 extends from the distal end 1143 of the hollowtube 1142. The distal surface 1152 of the attachment block 1150 isoffset and contoured to match the contour of the plate 300 at theattachment location. A plurality of ball end pins 1154 extend from thedistal surface 1152. The ball end pins 1154 are configured to align withand engage the indentations 344 in the plate 300 (see FIG. 6). Theengagement of the ball end pins 1154 in the indentations 344 ensures aproper orientation of the attachment post 1140 with the plate 300, andthereby, a proper orientation of the aiming arm 1102 with the plate 300.A continuous through bore 1144 extends through the attachment post 1140from the orienting boss 1146, through the hollow tube 1142 and throughthe attachment block 1150 such that the attachment post 1140 may be slidover the threaded shaft 1130. The cannulation through the post 1140matches the angle of the shaft 1130 relative to the top of the plate 300as shown in FIG. 30. As such, once assembled, the trajectories of theholes 1110 in the aiming arm 1102 will align with the trajectories ofthe holes 328, 330, 332 in the shaft of the plate 300.

Referring to FIGS. 29 and 30, the two-piece fastener includes the washer1160 and the spherical nut 1170. The purpose of the two-piece fasteneris to provide a simplified, streamlined assembly mechanism that permitslagging of the plate 300, post 1140, and aiming arm 1102 together in onestep. As the axis A1 of the threaded shaft 1130 and the plane P1 of theaiming arm's mating surface are not normal to one another, the fastenerrequired to lag the guide system together must be able to be oriented tothe shaft 1130 and the aiming arm 1102 individually. The washer 1160 andspherical nut 1170 described herein achieve such individual orientation.The pre-determined orientation would be fixed such that the bottomsurface of the washer would lie flush with the top surface of the aimingarm and the central axis of the nut would lie co-axial with the centralaxis of the threaded shaft. The washer 1160 includes a base member 1162with a contact surface 1164. A hole 1163 extends through the base member1162 such that the threaded shaft 1130 may pass therethrough. Aplurality of fingers 1166 extend upward from the base member 1162. Thefingers 1166 along with the base member 1162 define a semi-sphericalseat 1168 for the spherical nut 1170.

The spherical nut 1170 includes a shaft 1172 extending between a ballportion 1174 and a handle member 1176. The ball portion 1174 has asemi-spherical configuration which complements that of the seat 1168.The fingers 1166 are configured to allow the ball portion 1174 of thespherical nut 1170 to be snapped into the seat 1168 and thereafterretain the ball portion 1174 within the seat 1168. With such aconfiguration, the spherical nut 1170 can move freely within the washer1160 but remains contained to avoid additional parts. A distal end ofthe ball portion 1174 defines an opening 1175 into a threaded bore 1178.The threaded bore 1178 is configured to threadably engage the threads1134, 1136 at either end 1131, 1133 of the threaded shaft 1130. When thespherical nut 1170 is oriented with the threaded shaft 1130 andtightened, the washer 1160 self-aligns with the mating surface of theaiming arm 1102, completing the rigid connection of the arm 1102 to theplate 300.

Referring to FIGS. 31 and 31, a guide assembly with an alternativeembodiment of the connection assembly 1128′ will be described. In thepresent embodiment, the two-piece fastener is replaced with a fixed axisfastener including a washer 1160′ and nut 1170′ which are fixed togethersuch that the nut 1170′ is rotatable about a singular axis A2. The angleof axis A2 is selected to match the angle of the axis A1 of theattachment post 1140. The washer 1160′ includes a base member 1162′which defines a contact surface 1164. A nut attachment shaft 1165extends from the base member 1162′ and is configured to receive androtatably retain the shaft 1172′ of the nut 1170′. The nut shaft 1172′may be connected to the nut attachment shaft 1165 via radial tabsengaging a rim within the nut attachment shaft 1165 or any othersuitable means for rotatably connecting the nut shaft 1172′ to the nutattachment shaft 1165. The fixed orientation of the nut attachment shaft1165, only permits rotational motion of the nut 1170′ about the nut'scentral axis. The nut shaft 1172′ includes internal threads configuredto threadably engage the threads 1134, 1136 at either end 1131, 1133 ofthe threaded shaft 1130. With the angle of the axis A2 of the nut 1170′matching that of the attachment post axis A1, the contact surface 1164of the washer 1160′ will be parallel to and lie against the surface ofthe arm body 1104.

Having generally described the components of the connection assembly1128, attachment of the aiming arm 1102 to the plate 300 will bedescribed with reference to FIGS. 29 and 30. As a first step, thethreaded shaft 1130 is assembled onto the plate 300. The threads 1136threadably engage the threads of one of the holes 340 in the plate 300.The threaded shaft 1130 can be final tightened with a hexalobescrewdriver or the like engaged with the driver-engagement bore 1135.The attachment post 1140 is slid over the threaded shaft 1130 and theball end pins 1154 align with and engage the indentations 344 in theplate 300. The aiming arm 1102 is then positioned such that theorienting boss 1146 is received in the attachment slot 1108. Thetwo-piece fastener is then positioned such that the contact surface 1164of the washer 1160 sits on the upper surface of the aiming arm 1102 andthe threaded shaft 1130 is received into the threaded bore 1178 of thespherical nut 1170. The handle 1176 is then used to tighten the nut 1170as the threaded bore 1178 engages the threads 1134. As the spherical nut1170 is tightened, the washer 1160 self-aligns with the mating surfaceof the aiming arm 1102, completing the rigid connection of the arm 1102to the plate 300. As can be seen from FIGS. 29 and 30, upon connection,the plane P1 of the mating surface 1148 of the attachment post 1140 andthe plane P2 of the contact surface 1164 of the washer 1160 are parallelto one another. Accordingly, the trajectories of the holes 1110 in theaiming arm 1102 will align with the trajectories of the holes 328, 330,332 in the shaft of the plate 300.

Referring to FIGS. 33 and 34, an embodiment of a tissue protectionsleeve 1180 will be described. The tissue protection sleeve 1180 isconfigured to be inserted into one of the aiming holes 1110 with a1-to-1 association with the holes 328, 330, 332 in either the narrow orbroad lateral plates 300. The tissue protection sleeve 1180 includes ashaft 1182 extending from a proximal end 1181 to a distal end 1183. Athrough bore 1184 extends through the shaft 1182 from the proximal end1181 to the distal end 1183. The distal end 1183 may have a slight taperthereto to minimize tissue disruption.

As described above, a head member 1186 configured to seat in a desiredorientation within the recess 1114 of one of the aiming holes 1110 isdefined at the proximal end 1181 of the shaft 1182. Additionally, theproximal end 1181 of the shaft 1182 defines the locking tab 1196 whichis configured to engage in the undercut 1116 of the aiming hole 1110.The locking tab 1196 is releasable such that the sleeve 1180 isremovable from the aiming hole 1110. To facilitate such, a slot 1194 isdefined in the shaft 1182 such that a pivotal locking arm 1190 isdefined. The free end of the pivotal locking arm 1190 defines anunlocking button 1192. The locking tab 1196 is positioned along thelocking arm 1190 distally of the unlocking button 1192. The locking tab1196 has a sloped surface extending to the retention ledge 1198.Accordingly, as the tissue protection sleeve 1180 is inserted into theaiming hole 1110, the sloped surface of the locking tab 1196 willcontact the through bore 1112 and the locking arm 1190 will pivotradially inward, allowing the locking tab 1196 to pass through the bore1112. Once the locking tab 1196 passes the bore 1112 and is aligned withthe undercut 1116, the pivotal locking arm 1190 will automaticallyreturn to its initial position, with the retention ledge 1198 engagingthe undercut 1116, as shown in FIG. 34. In at least one embodiment, wheninserted properly, an audible click is heard as the retention ledge 1198engages the aiming hole's undercut 1116. To remove the tissue protectionsleeve 1180, the unlocking button 1192 is squeezed toward the headportion 1186 of the sleeve 1180, releasing the ledge 1198 from theundercut 1116. The sleeve 1180 can then be pulled free from the aimingarm 1102. With reference to FIG. 21, the tissue protection sleeve 1180may receive instruments directly, for example, trocar 1245, or mayreceive additional sleeves, for example, drilling sleeve 1200 or dynamiccompression sleeve 1250, which in turn receive instruments.

In the illustrated embodiment, the kickstand tissue protection sleeve1180′ is substantially the same as the tissue protection sleeves 1180described above except at the proximal end 1181′ thereof. Instead of ahead member 1186 and locking arm 1190, a handle 1255 extends radiallyfrom the proximal end 1181′. The handle 1255 facilitates greater controland rotation of the kickstand tissue protection sleeve 1180′ as it isinserted at an angle relative to the bone plate 300. In other aspects,the sleeve 1180′ is the same as in the previous embodiment andfacilitates passage of drill sleeves, screws and the like as describedherein.

Referring to FIGS. 35 and 36, an embodiment of a drill sleeve 1200positionable within one of the tissue protection sleeves 1180, 1180′will be described. The drill sleeve 1200 includes an outer sleeve body1202 extending from a proximal end 1201 to a distal end 1203. A throughbore 1204 extends through the outer body sleeve 1202 from the proximalend 1201 to the distal end 1203. A collet 1206 is defined at the distalend 1203 of the outer sleeve body 1202. Slots 1208 on either side of theouter sleeve body 1202 allow the collet 1206 to collapse and return toits natural expanded position. The drill sleeve 1200 also includes aninner drill sleeve body 1210 which extends from a proximal end 1211 to adistal end 1213. A through bore 1214 extends through the inner bodysleeve 1210 from the proximal end 1211 to the distal end 1213. Thedistal end 1213 of the inner drill sleeve 1210 is sized to be positionedwithin the bore 1204 of the outer sleeve body 1202. The proximal end1211 of the inner drill sleeve body 1210 includes a gripable head member1216 and a rotation tab 1218. In an initial position, the inner sleevebody 1210 is only partially inserted into the outer sleeve body 1202such that the distal end 1213 thereof is clear of the collapsible collet1206.

The drill sleeve 1200 may be inserted into one of the tissue protectionsleeves 1180, 1180′ with the inner sleeve body 1210 in the initialposition. The drill sleeve 1200 is advanced through the tissueprotection sleeve 1180, 1180′ until the collet 1206 of the outer sleevebody 1202 compresses and snaps into any of the holes 328, 330, 332, 335of the plate 300. Once the outer sleeve body 1202 is fully seated, thecollet 1206 is held in the expanded position by depressing the innersleeve body 1210 until the distal end 1213 thereof is aligned with thecollet 1206, as illustrated in FIG. 36. In the illustrated embodiment,the inner sleeve body 1210 is depressed by rotating the tab 1218. Inother embodiments of the drill sleeve, this can be achieved by pressingaxially, rotating a nut, depressing a lever, or the like. With the drillsleeve 1200 locked in place, the inner sleeve through bore 1214 isconfigured to receive various instruments, for example, as shown in FIG.21, a drill 1230, a k-wire 1235, or a positioning pin 1240.

Alternatively, a dynamic compression sleeve 1250 can be inserted intothe tissue protection sleeve 1180 to allow off-axis predrilling andpermit compression through a dynamic compression hole 332 in eitherdirection in the long axis of the plate 300. The dynamic compressionsleeve has a bore 1252 with an axis that is offset a given distance, forexample, by about 1 mm, from the central axis of the sleeve 1250. Withthe sleeve 1250 in a first orientation, the off axis bore 1252 is offsetthe given distance in the proximal direction of the plate 300 and whenrotated 180°, is offset the given distance in the distal direction ofthe plate 300. The sleeve 1250 has a tab 1254 which is aligned andpress-fit into a tab in the head member 1186 of the tissue protectionsleeve 1180 to properly clock its orientation. The holes 1110 in theaiming arm 1102 that align with dynamic compression holes 332 in theplate 300 may be marked, for example, outlined with white paint 1119 onthe aiming arm.

Referring to FIGS. 21 and 37, a hole marker 1220 may also press-fit intoone of the aiming holes 1110 to allow marking either the last hole in aplate being targeted or a hole which has already been filled with ascrew. In the illustrated embodiment, the hole marker 1220 has a handleportion 1222 with a pair of legs 1224 depending therefrom. The legs 1224are separated from one another by a gap 1227. A circular cut 1226adjacent the handle portion 1222 allows the legs 1224 to pivot towardone another upon application of an inward force, but then automaticallyreturn to the initial position upon removal of such force. The outersides 1229 of each leg 1224 have a taper such that as the legs 1224 aremoved into the through bore 1112 of one of the aiming holes 1110, thelegs 1224 will pivot toward one another and pass through. Each leg 1224also has an outer notch defined therein 1228. When the hole marker 1220is completely seated in the recess 1114 of the aiming hole 1110, thenotch 1228 will receive and engage the wall of the through bore 1112 asthe legs 1224 move back toward the initial position. The notches 1228are sloped such that a sufficient removal force on the handle portion1222 will cause the leg 1224 to again pivot toward one another and passin the reverse direction through the through bore 1112.

The aiming guide system 1100 described herein allows for improvedlateral imaging and visualization of the fracture. Due to the obliqueangle of the threaded shaft 1130, fracture lines are clearly visible inthe metaphyseal region of the femur, and access to the distal holes 340in the head of the plate 300 is maintained. The system 1100 also hasfewer components and fewer total assembly steps, allowing for simpleroperation and a more streamlined procedure than some of the otheravailable guides.

Attachment of the aiming arm 1102 to the plate 300 is achieved via asmaller rigid connection to the plate than most others on the market.This smaller connection is also located more distally in the plate thanother competitive options. Therefore, a smaller incision placed moredistally (closer to the articular surface of the knee) can be achieved.With a smaller MIS incision, excessive stripping of the soft tissueand/or periosteum can be avoided and there is a lower chance of woundcomplications.

Oblique “kickstand” screw holes in a distal femur plate are a unique wayto engage the strong bone on the medial condyle of the femur and promotestabilization of the construct through triangular, off-axis fixation.Providing a way to target the nominal axis of the kickstand holesthrough the guide system allows an easier, MIS approach to placinglocking or non-locking screws in these oblique holes.

One skilled in the art will appreciate that the embodiments discussedabove are non-limiting. While bone plates may be described as suitablefor a particular approach (e.g., medial or lateral), one skilled in theart will appreciate that the bone plates can be used for multipleapproaches. In addition, while bone plates are described as havingparticular holes (e.g., locking or non-locking), one skilled in the artwill appreciate that any of the bone plates can include locking,non-locking or a combination of locking and non-locking holes. Inaddition to the bone plates, screws and instruments described above, oneskilled in the art will appreciate that these described features can beused with a number of trauma treatment instruments and implants,including external fixators, ring fixators, rods, and other plates andscrews. It will also be appreciated that one or more features of oneembodiment may be partially or fully incorporated into one or more otherembodiments described herein.

What is claimed is:
 1. A method of stabilizing bone comprising the stepsof: providing an aiming guide system configured for connection to a boneplate, the bone plate extending along a longitudinal axis and comprisinga proximal portion, a shaft, and a distal portion, the bone platedefining a plurality of first screw holes along shaft, a plurality ofsecond screw holes at the distal portion, and an attachment screw holeproximate the distal portion, the guide system comprising: an aiming armhaving a rigid body extending from a proximal end to a distal end with aplurality of aiming holes defined through the rigid body between theproximal end and the distal end thereof, the distal end defining anattachment slot through the body, and; a connection assembly configuredto engage the attachment screw hole and the attachment slot such thatthe aiming arm is fixed in position relative to the bone plate with eachof the plurality of aiming holes aligned with a respective one of thefirst screw holes at least one tissue protection sleeve configured to bepositioned through one of the plurality of aiming holes such that thetissue protection sleeve defines a through bore from the aiming guide toa respective one of the first screw holes; and positioning at least onedrill sleeve through the tissue protection sleeve, the at least onedrill sleeve having an outer sleeve body with a collapsible collet at adistal end thereof and an inner sleeve body extendable within the outersleeve body such that the inner sleeve body engages the collet andmaintains the collet in connection with one of the first screw holes. 2.The method of claim 1 wherein the connection assembly includes anattachment post having a first end with an orienting boss extending froma mating surface, the orienting boss is configured to be received inattachment slot such that the aiming arm rests on the mating surface anda predetermined angular orientation of the aiming arm relative to theattachment post is maintained.
 3. The method of claim 2 wherein theorienting boss and the attachment slot have complementary configurationswhich are configured such that they mate only when the aiming arm isproperly oriented.
 4. The method of claim 3 wherein the orienting bosshas a keying member extending therefrom and the attachment slot has agroove configured to receive the keying member when the aiming arm isproperly oriented.
 5. The method of claim 2 wherein the attachment postincludes an attachment block at a second end, the attachment blockhaving a distal surface which defines a plurality of ball end pins, eachball end pin configured to be received in a respective indentation onthe plate surface about the attachment screw hole, wherein positioningof the ball end pins within the indentations properly aligns theattachment post relative to the plate.
 6. The method of claim 2 whereinthe attachment post is configured to extend at an oblique angle withrespect to the bone plate such that the attachment post and aiming armdo not overlie the second screw holes.
 7. The method of claim 2 whereinthe connection assembly further includes a threaded shaft having a shaftbody extending between first and second ends, each end including aplurality of threads, the threaded shaft extending through a throughbore of the attachment post with the threads of at least one of thefirst and second ends of the shaft body configured to threadably engagethe attachment screw hole.
 8. The method of claim 7 wherein theconnection assembly further comprises a fastener configured tothreadably engage the threads on at least one of the threaded shaft tosecure the attachment post between the aiming arm and bone plate.
 9. Themethod of claim 8, wherein the fastener includes a washer, the washerhaving a contact surface defined on one side thereof and asemi-spherical seat defined on the opposite side thereof, and aspherical nut, the spherical nut has a ball portion having asemi-spherical configuration which complements that of the seat, theball portion defining a threaded bore configured to threadably receiveat least one end of the threaded shaft.
 10. The method of claim 9wherein the during tightening of the threaded nut, engagement betweenthe ball portion and the semi-spherical seat causes the washer toself-align with the contact surface generally parallel to the matingsurface of the attachment post.
 11. The method of claim 1 wherein aprojection extends from at least one side surface of aiming arm body,the projection defines an angled aiming hole configured to align with akickstand screw hole of the bone plate.
 12. The method of claim 1further comprising at least one tissue protection sleeve configured tobe positioned through one of the plurality of aiming holes such that thetissue protection sleeve defines a through bore from the aiming guide toa respective one of the first screw holes.
 13. The method of claim 1wherein the tissue protection sleeve has a head member at a proximateend thereof and the head member is configured to be received in a recessdefined by the aiming hole to retain the tissue protection sleeve in adesired orientation.
 14. The method of claim 13 wherein a releasablelocking tab along the tissue protection sleeve is configured to engagean undercut in the aiming hole to releasably secure the tissueprotection sleeve to the aiming arm.
 15. The method of claim 1 furthercomprising at least one dynamic compression sleeve configured to bepositioned through a tissue protection sleeve, the at least one dynamiccompression sleeve having a through bore offset from a central axis ofthe dynamic compression sleeve.
 16. The method of claim 1 wherein theaiming arm is shaped to be reversible such that one side is adapted tobe used for a lefthanded plate and the other side adapted to be used fora righthanded plate.
 17. A method of stabilizing bone comprising thesteps of: providing an aiming guide system configured for connection toa bone plate, the bone plate extending along a longitudinal axis andcomprising a proximal portion, a shaft, and a distal portion, the boneplate defining a plurality of first screw holes along shaft, a pluralityof second screw holes at the distal portion, and an attachment screwhole proximate the distal portion, the guide system comprising: anaiming arm having a rigid body extending from a proximal end to a distalend with a plurality of aiming holes defined through the rigid bodybetween the proximal end and the distal end thereof, the distal enddefining an attachment slot through the body, and; a connection assemblyconfigured to engage the attachment screw hole and the attachment slotsuch that the aiming arm is fixed in position relative to the bone platewith each of the plurality of aiming holes aligned with a respective oneof the first screw holes, the connection assembly comprising: anattachment post having a first end with an orienting boss extending froma mating surface, the orienting boss is configured to be received inattachment slot such that the aiming arm rests on the mating surface andis maintained in a proper orientation, and a second end having anattachment block, the attachment block having a distal surface whichdefines a plurality of ball end pins, each ball end pin configured to bereceived in a respective indentation on the plate surface about theattachment screw hole; a threaded shaft having a shaft body extendingbetween first and second ends, each end including a plurality ofthreads, the threaded shaft extending through a through bore of theattachment post with the threads of at least one of the first and secondends of the shaft body configured to threadably engage the attachmentscrew hole; and engaging a fastener on at least one of the threadedshaft to secure the attachment post between the aiming arm and boneplate.
 18. The method of claim 17, wherein the fastener includes awasher, the washer having a contact surface defined on one side thereofand a semi-spherical seat defined on the opposite side thereof, and aspherical nut, the spherical nut has a ball portion having asemi-spherical configuration which complements that of the seat, theball portion defining a threaded bore configured to threadably receiveat least one end of the threaded shaft.
 19. A method of securing anaiming guide arm relative to a bone plate, the aiming guide arm having arigid body extending from a proximal end to a distal end with aplurality of aiming holes defined through the rigid body between theproximal end and the distal end thereof, the distal end defining anattachment slot through the body, the bone plate extending along alongitudinal axis and comprising a proximal portion, a shaft, and adistal portion, the bone plate defining a plurality of first screw holesalong shaft, a plurality of second screw holes at the distal portion, anattachment screw hole proximate the distal portion and a plurality ofindentations about the attachment screw hole, the method comprising:threadably engaging a first end of a threaded shaft in the attachmentscrew hole such that the threaded shaft extends from the bone plate atan oblique angle; sliding an attachment post over the threaded shaftsuch that ball end pins extending from an attachment block on one end ofthe attachment post seated within the indentations on the bone plate,the opposite end of the attachment post having an orienting bossextending from a mating surface; positioning the aiming guide arm withthe orienting boss extending through the attachment slot with a firstsurface of the aiming guide arm seated on the mating surface; andsecuring a fastener to a second end of the threaded shaft, the fastenerengaging a second surface of the body of the aiming guide opposite thefirst surface to secure the body of the aiming guide relative to thebone plate in a fixed orientation.